Background: Chronic myeloproliferative neoplasms (CMN) are the most common chronic leukemias among the elderly in the structure of morbidity by hematologic malignancies with primary bone marrow involvement, characterised in advanced stages by a severe, relapsing evolution and unfavourable prognosis, with negative socioeconomic impact.
Study Goals: To improve hematologic oncology care for older patients with chronic BCR-ABL-positive and BCR-ABL-negative myeloproliferative neoplasms, researchers evaluated diagnosis and management choices in chronic BCR-ABL-positive and BCR-ABL-negative myeloproliferative neoplasms.
Methods and Materials: A clinico-analytical, descriptive, prospective-retrospective investigation was carried out, as well as a narrative evaluation of the relevant international literature. From 1995 to 2021, the Institute of Oncology followed and treated 91 elderly patients with chronic myeloid leukaemia (CML), primary myelofibrosis (PMF), and polycythemia vera (PV). In terms of the impact scale, 29 appropriate primary sources were identified and selected using a rigorous, repeatable, and transparent approach to the topic at hand, followed by data extraction and analysis.
Our study followed up on 34 (37.3%) patients with PMF, 26 (28.6%) patients with CML, and 31 (34.1%) patients with PV who were diagnosed in the older age groups. The age group of 60-69 years old dominated CML (22 cases, or 84.6 percent), PV (25 cases, or 80.6 percent), and PMF (25 cases, or 73.5 percent). Overall survival (OS) was 97.6% and 79.8% in CML patients aged greater than or equal to 60 years treated with tyrosine kinase inhibitors (TKIs), respectively, which was lower than the same indicators in the entirety of CML. The OS in older PV patients was 100% after one year, 93.5 percent after five years, and 76.4 percent after ten years, all of which were lower within 5-10 years than in all PV patients (over one year, 98.6% after five years, and 85.9% after ten years). Despite the fact that patients treated with busulfan had a lower relapse rate than those treated with hydroxycarbamide, there was no significant difference in the OS of elderly PV patients receiving treatment with these anticancer drugs. According to contemporary bibliographic databases, a substantial percentage of patients with CMN suffered reduced work hours, job loss, and medical disability: PMF – 38 percent, 35 percent, 33 percent, and PV – 33 percent, 28 percent, and 15%, respectively.
Conclusions: Because of the development of age-related diseases and vascular events as a result of higher values of leukocytes and platelets, the long-term results of treatment in elderly patients with CMN were shown to be poorer to those in CMN totality. TKI-targeted therapy is still the first-line treatment choice for CML patients aged 60 and up. There was no significant difference in short- and long-term results of chemotherapy with busulfan and hydroxycarbamide in combination with phlebotomy in elderly PV patients, who were completely superior than PMF patients.Author(S) Details
Vasile Musteata
Discipline of Hematology, “Nicolae Testemitanu” State University of Medicine and Pharmacy, Republic of Moldova and Department of Hematology, Institute of Oncology Chisinau, Republic of Moldova.
Valentina Stratan
Laboratory of Immunology and Molecular Genetics, Institute of Oncology Chisinau, Republic of Moldova.
View Book:- https://stm.bookpi.org/IDMMR-V5/article/view/5591
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